ACL Diary: Let’s Get Physical

When Willow started driving, no one was happier about it than I. Primarily it meant that after 11 years, I no longer had to drive a carpool filled with smelly shin guards and crusty socks to and from soccer practice.

A month later she tore her ACL, and after surgery, I was back to being her chauffeur. I wasn’t taking her to soccer practice twice a week, however. I was taking her to physical therapy.

We chose John Woolf of ProActive Physical Therapy, as he came highly recommended by our surgeon, Dr. Tucker, as well as by trusted and knowledgeable friends.

“Talk to my husband,” said my good pal and fellow soccer mom, Stephanie Hunley, when I asked her if she had a therapist to recommend. “He’s got people.”

LaMonte Hunley, one of the men who carried Willow off the field on that dreadful day, is a low-key, yet loyal soccer dad. A former NFL player with the Indianapolis Colts and a U of A Wildcat, he doesn’t say much to or about the girls and the game, but when he does make a comment, in my never-humble opinion, he’s always spot on with his observations.

 

LaMonte Hunley

In addition to LaMonte’s credentials as a professional athlete, he’s an active businessman in the Tucson community. As co-owner of Arizona Health, which specializes in residential and commercial exercise equipment, he definitely knows people. So, when it came time to pick a local physical therapist for Willow’s immediate needs, without hesitation, I went to LaMonte.

“Woolf,” he said, almost like a bark.

“Did you say wolf? Like the canis species? A howling, doglike wolf?”

“Yeah, that’s right,” said LaMonte. “He’s the one. Used to be the trainer at the U of A.”

I immediately looked up Mr. Woolf and discovered he’s the former Director of Sports Medicine for The University of Arizona where he coordinated rehabilitation and medical coverage for division I athletes. Today he is the owner of ProActive Physical Therapy, located about a half hour from our eastside home. And it turned out, he was available to see Willow twice a week for the remainder of her time in Tucson this Spring.

John Woolf

Prior to meeting him, Willow’s friend, Anna, a teammate who has been back on the soccer field for over a year after ACL reconstruction surgery, told her that John was her physical therapist, too. And she said in no uncertain terms that he was “the best.”

“He deals with what’s up here,” she said pointing to her temple,” As well as what’s down here.” And she pointed to her knee.

I didn’t fully grasp what Anna meant until I watched John in action. My view from a very different sideline made me believe from the first session that we had chosen the right physical therapist for Willow. He not only brings excellent credentials and experience to the rehab table, but he’s also the father of a teenage girl.

“What color is the pain?” he asked Willow. “And what shape does it have?” As he worked with her knee, he asked a series of questions like this that obviously had a positive affect on Willow. Nevertheless, I think he had her at hello.

And so, I adjusted my driving route and my routine, and found that being at physical therapy during those first few sessions wasn’t that much different than being at soccer practice. My daughter was involved in an activity while I engaged in conversation with one of my long-time friends and fellow soccer mom, whose daughter was also working out with her therapist after ACL reconstruction surgery. (In the circle in which we travel, ACL tears are a BIG injury in a SMALL town).

I had only just begun to grasp the depth of the emotional impact of this injury, and will write more about that soon. But after a little more than two weeks post-op, when Willow begged me to let her drive again, I was nervous about letting her and therefore, reluctant. 


Ultimately I hoped that in conjunction with the physical therapy, a little motor vehicle therapy might go a long way in healing her hurt that day. Therefore, I handed her the keys and watched as her face lit up with a smile I hadn’t seen in a very long time.

“Score!” she said and practically skipped out the door.

ACL Diary: Embrace the Brace

Warning: Contains foul language
At Willow’s pre-op appointment with Dr. Tucker, one of his assistants fitted her for the brace that would become a big part of her support system for the first stage of her post-op experience.

It’s an uncomplicated device made partly of Velcro and plastic, but primarily of black, foamy material, on a par with a 7mm wetsuit, yet not quite as dense. Fitting her took less than five minutes. “How tall are you?” they asked. From there it was as easy as one, two, three.

Two minutes later, a nurse came into the exam room and told us our insurance didn’t cover the cost of the brace—for some reason she may as well have stated in Mandarin for as much sense as it made to me. “It’s unfortunate,” she said, “because the price on this is $915.

NINE-HUNDRED and FIFTEEN flippin’ DOLLARS?

The DonJoy IROM brace may be the Cadillac of post-operative knee braces, but come on! Of course, I realized this was an exorbitant markup and later, I went online to do a little research about these braces. Not one came close to the nine-hundred dollar mark. WTF?

It only took one “you gotta be kidding me,” comment said loudly enough for everyone in the building to hear, when someone suggested we use the self-pay option instead of dealing with the insurance company. “If you self-pay, the price goes down to $150.” Again, WTF?

After I tried to swallow this unbelievable discrepancy in price, I hobbled out of the office along side my injured daughter and, for about thirty seconds, allowed myself (for the first time) to actually think about what this ordeal was going to cost our family.

Lest this become a rant about the cost of health care in this country OR the fucked up insurance industry all of us who (think we) can afford health insurance has to deal with, I’ll get back to my original theme and EMBRACE the experience for what it is.

ACL buddies: Willow, showing off her brace; 

Shelley, showing off her healing wounds

Our daughter was injured, and no matter what it takes, we’re going to do what we can to heal her. (I reserve the right to freak out a little when the bills start coming in). Meanwhile, I still haven’t received the bill for the brace and don’t know if I’ll be charged a hundred-something bucks or nine times that amount for a device that is now stashed in a storage closet, hopefully, never to be seen or heard from again.

ACL Diary: The Ugly, The Bad and The Good

Willow’s dad—the true videographer in the family—was out of town during the game when she tore her ACL. This is why I was behind the camera.

I was recording for two reasons. One, so her dad could watch the game later, and two, because I was putting together college recruitment videos for Willow and another girl on the team, and I was hungry for highlights. Instead, however, I captured what can only be called a career lowlight.

There was nothing pretty about watching through the focused lens of the camera as my daughter collapsed. My immediate reaction, captured on the audio, was to distinctly breathe out my go-to ugly word: “shit.”

So, this whole ordeal—in spite of her good play leading up to this day—started with the ugly.

It’s obvious that Willow is a very pretty young woman; however, she was also a beautiful baby. At birth, this 6 lb. 12 oz newborn didn’t have a single mark on her body. No freckles, moles, spots or storkbites. We searched for birthmarks of any kind and found none. That’s changed, of course, over the past 16 years and I, for one, know that she has earned every spot, scar, nick and bruise. A majority of these marks, including the substantial slide strawberries on each hip, have come from soccer.

Three days after the ACL replacement surgery, we held our breath as we removed Willow’s dressings. Bracing ourselves for the big reveal—once we exposed her naked knee and laid eyes upon all the little patches of royal blue stitches marking the procedure, we didn’t know whether to crinkle our noses and utter a series of “ewwwwwwwwwwws,” OR purse our lips and say, “well, this isn’t so bad.”

The bad part, aside from the fact that it happened, was the timing of the surgery. Initially we thought it was good in that it coincided with Willow’s Spring break, however, it just so happened we had company at this time—planned long in advance—and our house was like a circus with non-stop commotion. Willow was so drugged out at first, that she didn’t notice; however, on Good Friday, the day after her surgery, she tried to join us for the annual Easter ritual of dying eggs.

Poor kid, she lasted only long enough to dip one egg in the blue dye before the clamor of the room was too much for her and she had to crutch her way back to her room.

Suffice it to say, one can usually find a way to express that the timing of an injury like this is just plain bad. It’s so distruptive to immediate and even longer-term plans. We cancelled our team’s participation in a college showcase event and we had to cancel soccer camp in July. There went that deposit up in smoke. An injury requiring months of rehab makes priorities change whether you like it or not.

Aah, but there was good. The good that came from the days following surgery was primarily from Willow’s BFF, Megan. She truly showed what a good friend she is. Megan and I were in touch via text from the moment Willow was in the recovery room, and once she knew we were on our way home, she wasted no time in getting to Willow’s bedside.

She remained there for most of their Spring break.

We already considered this darling young woman a part of our family; however, during this chaotic time, Megan added to the laughter in the room. She helped us eat our leftovers and dye our Easter eggs. She assisted Willow in every way she could, including putting on her bathing suit and getting Willow through her first traumatic shower on Saturday, which was shortly after we removed the bandages.

Megan wasn’t the only friend who showed her true colors at this time. Many, many friends and moms and members of Willow’s team came by with cards, balloons, candy, ice cream (lemon sorbet!) Easter baskets, Purple Heart proclamations, and poetry (in the form of rap—you KNOW who you are MAC), an ice machine, and a truckload of moral support. They held her hand, patted her head, kissed her cheek and offered their smiles. They made her laugh, and they made her feel very loved.

It was a pretty extreme way to find out who her good friends are; however, we know Willow was as grateful for the company and well wishes, as we were for the distractions to what we’d all just experienced.

Thanks everyone. You’re good friends and we love you.

ACL Diary: Clearing Hurdles

The Surgery Itself

Willow’s ACL tear happened during the first game of the 2011 AZ State Cup, which is the last tournament of the season, and the most important in terms of establishing team ranking. She was also in the midst of her school track season and had just posted her best time, three seconds off the previous week. Her event? 300 Hurdles.

Little did she figure on a whole new set of hurdles ahead of her that would cover a span of months rather than yards.

Clearing the hurdle over selecting what type of ACL reconstruction surgery to have, the next hurdle was scheduling the procedure. Dr. Todd Tucker, who we believe is the surgeon of choice for hamstring replacement in Tucson, had an opening on April 21. This was Willow’s first day of Spring Break, and at first we thought it was good timing, considering she’d miss fewer days of school.

Willow is a serious student, enrolled in demanding classes. Missing school might be considered a bonus to some kids; however, to Willow, who ultimately only missed two days, finding time for makeup work (particularly lengthy trigonometry problems) was an additional stressor we didn’t foresee. It nagged at me that we possibly should have waited until the school year ended; however, given our back-and-forth lifestyle (Tucson-Wisconsin-Tucson-Wisconsin-Tucson-Wisconsin) we decided to have the surgery here in Tucson—rather than during the midst of our busy season at Sandy Point Resort. Plus, Dr. Tucker wanted at least 4-5 weeks to monitor Willow’s initial post-surgery progress.

So, with an ETD for Wisconsin of May 26, we counted weeks on our fingers, and scheduled the date--April 21.

Mike and I were as worried as any parents of a child undergoing general anesthesia and the knife. Willow, on the other hand, was resolved. She may have simply believed that the sooner she had the surgery, the sooner she’d get back on the field. We were blessed to have a good friend, Karen Schwartz—aka KK—as her intake nurse at the Tucson Surgery Center. Her high beam smile and natural warmth eased us into the process.

KK and Wills in the recovery room

As she and the anesthesiologist prepped Willow, Dr. Tucker told us to expect the surgery to take 1-1/2 to 2-1/2 hours. He, of course, knew what to expect with the ACL, but he wasn’t certain about the meniscus. Since 50% of these injuries tend to also include meniscus damage, and the MRI wasn’t definitive, he wouldn’t know until he got in there. His plan was to repair the meniscus if necessary, or remove any damage if determined to be insignificant.

Granted, 1-1/2 to 2-1/2 hours wasn’t a large stretch of time in the waiting room, but timing is everything when running hurdles. One needs to know when to expect the next jump—right down to the millisecond.

I passed the time doing the Thursday Merl Reagle crossword and the Suduko puzzles in the AZ Star, while Mike went to Starbucks for his nineteenth nervous non-fat latte.

And then, merely an hour after we watched Willow wheeled away, Dr. Tucker came into the waiting room. He spotted us at once and a smile filled his face.

All I can say is that at this moment, our hearts leapt.

ACL Diary: Pain and Percocet

“Has it really been less than three weeks?”

On the news this morning, I heard that it’s been three weeks since Holly Bobo, the nursing student from Tennessee, was abducted in her front yard. These periodic abduction stories tend to upset my husband and cause him to worry about the safety of his own daughters.

But this one, the story of Holly Bobo, really got to him.

I’m not sure if it was because Holly’s blonde and beautiful (and bears a resemblance to Willow), or if it was more about the timing of the incident and how it coincided with fears over Willow’s pending surgery.

What I am sure of is how it seems like we first heard about Holly’s abduction a long time ago. Has it really only been three weeks? And are we really only just shy of three weeks since Willow’s surgery?

Holly

Willow

I’m sitting here wondering, how is it this school year has flown by so quickly and yet, the last few weeks have dragged on and on? It hasn’t been about an empty calendar—on the contrary—nor has it been due to any lack of drama. Since Willow’s injury on April 2, our drama content has been on steroids.

Scratch that. Our drama has been on Percocet.

I’ve never taken a Percocet, so I have no clue about how they make one feel. When they were prescribed for our daughter’s pain I asked our nurse, Karen Schwartz (who happens to be a good friend), about the purpose of these pills. “Is this the kind of medicine that actually goes to and stops the pain, or is it just something that zones you out and makes you not care so much about it?”

“It goes to the pain,” Karen said emphatically.

So, I filled the scrip, created a time and dosage chart, and issued these pills to my child every three-to-four hours for the first two days. I kept her good and loopy while a parade of friends came by to see her during what were the first two days of their spring break.

Willow hardly remembers the specifics of anything of what she said or did for at least 24 hours after the surgery. But trust me, she was darn funny. We were told she’d start feeling better by day three, and this was when she could remove the dressings and take a shower. This is also when we decreased the dosage, and then proceeded to stretch out the hours between administering pills.

And now here we are 16 days post surgery—16 days that feel like 16 weeks—and Willow now resorts more to the ice machine and Advil to deal with the pain. We still have several precious Percocet pills, but save them for the hour before she goes to her physical therapy appointments.

In other words, we’re no longer charting the days in terms of hours and pain pills. And because of this, perhaps time will once again go speeding by, and we’ll be that much closer to Willow’s complete recovery.

P.S. To Holly’s family: We are so sorry this has happened. We keep you all in our thoughts, and pray for her safe return to you.

ACL Diary: Patellar? Hamstring?

“Go With Your Gut”
The first thing we learned is that shredded ACL ligaments cannot be repaired. They may, however, be reconstructed. It wasn’t until we saw the MRI images and our surgeon pointed out the barely visible frayed remains of Willow’s ACL, that we truly understood.

Options for ACL reconstruction surgery presented to us were:

• Patellar Tendon 
• Hamstring Tendon
• Allograft (Donor Tissue)

Given Willow’s desire to return to competitive soccer, Dr. Tucker ruled out allograft, indicating it was not the strongest option. He then explained the patellar and hamstring tendon techniques, citing both as viable options, and listed the advantages and disadvantages attributed to each.

So then it was left to us to decide. And this is what occupied my brain for the next several days:

Patellar? Hamstring?
Patellar? Hamstring?
Patellar? Hamstring?
Patellar? Hamstring?
Patellar? Hamstring?
Patellar? Hamstring?

Two friends here in Tucson, both nurses, have daughters who had been Willow’s teammates in the past, and had torn their ACLs. When they learned of Willow’s injury, they made a point of contacting me to offer advice, opinions and especially moral support. In fact, they both said to me—one through email and one on the phone—“I know EXACTLY what you’re going through.” Even though I didn’t realize I’d soon become a bona fide ACL reconstruction procedure “expert” on a par with them, they made it immediately apparent that both my daughter and I would survive this ordeal.

District Champion Bobcats, Cass and Wills, 2009

Like Dr. Tucker, these fellow soccer moms discussed the options available to us and didn’t necessarily recommend one procedure over another. Of course they shared the methods they chose, which included both patellar and allograft, but they encouraged me to do my own research, and go with my gut.

The nurses weren’t the only soccer moms and/or dads who contacted me. Parents of other teammates—past and present—who have faced this, and friends from high school and other former lives offered empathy and information.

As my source list grew, so did my research folder.

In short, my research showed that even though the patellar surgery was once considered the gold standard, with recent improvements to the hamstring technique, it’s close to impossible to find anything or anyone that can or will objectively recommend one procedure over the other as being “better.”

95 Rush Team, 2006-07 . . . Four Future Knee Surgeries

Even after factoring in gender and body type, ultimately our choice became an exercise in choosing among the DISADVANTAGES.

With the patellar what stood out was the potential for long-term frontal knee pain and the possibility of future patellar fracture/injury; and with the hamstring we understood a risk of the tendon stretching and thereby causing re-injury.

It wasn’t long before I threw my hands in the air and prayed out loud for someone to “tell me what to do!”

And then, someone did.

I phoned a Sports Medicine physician in Wisconsin, Dr. James Mullen with Premier Physical Medicine and Wellness Clinic, to tell him about the injury. (Willow trained with him in a speed and agility course all last summer). Dr. Mullen is a six-time member of the U.S. National Speed Skating Team and an inductee of the Wisconsin Soccer Association Hall of Fame.  He also has multiple top 200 American Birkebeiner finishes (x-country skiing marathon) and still actively races.

When I told Dr. Mullen about Willow’s injury, he couldn’t help but express his disappointment given that last summer’s training was all about ACL injury prevention (ugh!) And before I even asked his opinion regarding the procedures, he advised us to go with the hamstring replacement for Willow.

“Hamstring has gotten a bad rap in the past,” he said, “but today the surgery includes braiding of the tendon to make it stronger, as well as a vastly improved reattachment technique. There’s far less of a chance of stretching.” Mullen went on to say that it would be the surgery he’d chose for himself.

Can you guess how many surgeries these girls represent?

The athletic trainer at Sabino High School, Connie Rauser, who conducted a drawer test on Willow and used her knee as the subject of one of her sports medicine classes, was, like Dr. Tucker, certain of an ACL tear. She, too, recommended the hamstring replacement surgery.

Finally, it was Willow herself who decided hamstring was the way she wanted to go. And as she so often will remind me that this is HER life, in the case of her torn ACL and replacement surgery, she was quick to point out as well that this was indeed, HER knee.

ACL Diary: Making Choices

"Someone, Please Tell Me What To Do!"
One of the complications of living in the United States, and I’ve often made this observation when facing a big decision, is that there’s far too much choice. I may have first had this feeling when doing something as trivial as walking down the cereal aisle at the grocery store. Looking at an overwhelming wall of some 500 choices of commercial brands alone—and who knows how many generic—more often than not, I still end up choosing the tried-and-true yellow box of Cheerios.

There aren’t as many orthopedic surgeons in Tucson as there are brands of cereal; however, I’d say there are at least a hundred, and since we know several girls who had torn their ACLs and had repair surgery, personal referrals were quick to arise. (By the way, EVERYONE thinks his/her surgeon is a rock star!)

When considering credentials, you must decide whether or not your child should still see a pediatric surgeon, and this may be based on the state of her growth plates. The x-rays we took at Urgent Care showed that the legs of my 16 year-old, 5’-9” daughter would not grow any longer—growth plates decisively closed—and therefore we chose to treat her as a “level one athlete” rather than a child. This led us to consider surgeons specializing in sports medicine. And naturally, we wanted a surgeon who’d already accomplished many, many ACL repairs.

One of the surgeons whose name was high on our list—we knew two girls who’d recently been his patients—had an early afternoon cancellation two days after Willow’s injury. Wanting some immediate answers, we jumped on that appointment. Dr. Tucker (and his fellow), each gave Willow what’s known as a “drawer test,” to determine the nature of her injury. Tucker was certain he was looking at another torn ACL, but regardless, he gave Willow odds prior to scheduling an MRI.

This was her Facebook status update after the appointment.

Willow Cozzens

Soo 75-90% chance it's my ACL. in my mind that means 10-25% chance it's not. 
LET'S HOPE I BEAT THE ODDS




Willow didn’t beat those odds, bless her heart. And as a result, we had to make another major decision, and that was what type of ACL repair surgery we wanted to use. And this was, perhaps, the most difficult choice we had to make.

ACL Diary: The Immediate Aftermath

A Hundred Phone Calls

Willow and I sat for about an hour in the Urgent Care waiting room on the Saturday afternoon she went down, and our dear friend, Mike Smith—my sometimes second (soccer) husband—brought Willow a burger and a chocolate shake. It turns out that it was the most food she’d eat for the next several weeks. The minute she started taking painkillers, she booted her food and lost her appetite.

Urgent Care can only do so much, especially on a Saturday when doctors aren’t on staff. A kind nurse named “Jim-bo” saw to her x-rays and put it in writing that there were no broken bones, and that he suspected an ACL tear. He didn’t know that an explanation of the injury wasn’t necessary, but—bless his heart—he told us a lot of things we didn’t really care to hear.

The minute we got home, the phone calls began. This means I both made them and answered them. I didn’t cry until I spoke with my pal Stephanie Hunley, who it might be fair to call my soccer wife. Actually, she’s that soccer mom—that best friend—we soccer moms make when our kids are so involved with a team that it practically takes over our lives. We have vested interests in each other’s kids, and love them like our own. We understand our kids’ health and the way they perform on the field has a direct impact on the success of the team.

“Can I lose it now?” I asked her.

“Go right ahead,” she said, and allowed me to talk through my fear and my tears.

It was a momentary, necessary lapse, and once I got it out of my system, I went into research mode. I needed to figure out HOW we were going to handle this injury.

One of the first calls I made was to my friend, Gillian Borden, because we go to the same church and I wanted her to get Willow on the Sunday morning prayer list. (I knew we needed all the strength-to-get-through-this power we could get, and for me, this is what prayer is all about.) I had forgotten that Gillian is married to a physical therapist and had a lot of information about local, reputable orthopaedic surgeons. Additionally, she lives across the street from my former soccer wife/soccer mom and co-manager of a club team, whose daughter also suffered an ACL tear back in October. I scribbled furiously as Gillian provided names of surgeons and other necessary information. She was my angel and Gillian, please know how grateful I am to you.

The next day, Sunday, Willow and I drove to Casa Grande to watch her teammates win their second State Cup Game. Although they were now in the loser’s bracket, it’s a double-elimination tournament and all was not lost with the first game the day before. Meantime, soccer mom, Maureen Shields, gave us a handicap parking tag for our car so we could park right next to the field and she allowed me to cry on her shoulder before the game.

Willow didn’t cry until after the game—until she realized how hard it would be to sit on the sideline and watch rather than be out there contributing.

In spite of the victory, it was a long ride home.

ACL Diary: And So Begins the Rehab

Thursday, April 28, 2011

From the moment my daughter went down on the soccer field, my guts told me what we’d be facing. But there wasn’t any way to truly prepare for the emotions her ACL injury would invoke. It has been just shy of a full lunar cycle since the incident—26 days—only one week out of surgery, and already I feel like a seasoned veteran of the course that is the treatment of an ACL injury.

Since 220,000 female athletes under the age of 21 face this specific injury each year, and I have personally now witnessed too many of these plant-twist-pop-collapse episodes to count, I believe it’s important to document our experience. Those with children who have torn their ACLs will relate and empathize, and those who are at the very beginning of this journey toward repair and rehabilitation will hopefully appreciate and learn from our experience. (ACL stands for Anterior Cruciate Ligament, which is one of the four major ligaments in the knee). And if you're the parent of an athlete—especially a soccer or basketball player—please take note of the statistics and add ACL prevention training to your kid's regular workout.

We are filled with gratitude for so many friends who have helped us through the process so far. For a while, it seemed as though a day didn’t go by where I didn’t hear from or learn of another young athlete who had torn his/her ACL. It’s sad how many we know, but also knowing we’re not alone has been healing in itself.

First of all, in case you haven’t been on the sidelines of a thousand soccer games, I’ve compiled a very brief video with three examples of the typical defensive move made by Willow (#24) during any given game, which was the same move that led to her injury. These clips show her chasing down the ball and/or offensive player with the ball, successfully taking possession and changing direction.

This next video, which is still painful for us to watch, shows the same sort of run up the sideline, but this time Willow was NOT successful. She turns on her right foot, but her left gets caught up on the leg of the player she’s marking, and she goes down. According to her surgeon, Dr. Todd Tucker of the Tucson Orthopaedic Institute, Willow didn’t just tear the ACL on her right knee, “she shredded it.”

Day 1: April 2, 2011

Arizona State Cup, Game 1

TVSC 95 Samba vs. 95 Valparaiso

Golf Links Field D, Tucson, AZ

Many of us suspected and even knew we had just witnessed an ACL injury. Team dads, LaMonte Hunley and Tony Guerrero (whose own daughter suffered an ACL tear some three years ago), carried Willow off the field and brought her to the arms of team mom/athlete, Shannah Biggan, and another teammate, the lovely Olivia Ortiz—also recovering from ACL surgery. I ran to get ice and tried to breathe rather than hyperventilate. I also called my husband, Mike, who was in Prescott with Camille and her soccer team, and broke the bad news.

When I returned to the sideline, Willow was as upset about the pain in her knee as she was about not being on the field, and letting down her Samba teammates. But there was no way Willow was going back in that game.

Samba lost 0-1.